Provider Demographics
NPI:1679211791
Name:FAMILY FOOT HEALTH SPECIALISTS OF FARMINGTON, LLC
Entity Type:Organization
Organization Name:FAMILY FOOT HEALTH SPECIALISTS OF FARMINGTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:DORNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:505-860-4919
Mailing Address - Street 1:4801 N BUTLER AVE STE 14-102
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-0815
Mailing Address - Country:US
Mailing Address - Phone:505-327-3650
Mailing Address - Fax:505-327-2350
Practice Address - Street 1:4801 N BUTLER AVE STE 14-102
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-0815
Practice Address - Country:US
Practice Address - Phone:505-327-3650
Practice Address - Fax:505-327-2350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1740286780OtherNPI